Myocardial infarction during pregnancy

Up to now 136 cases of myocardial infarction during pregnancy have been rep orted, and angiography revealed normal findings in 47%. In these cases coro nary spasms have been discussed as the major mechanism of the disease. In i solated cases coronary artery dissection may also present with a normal cor onary angiography. The case of a 31-year-old pregnant woman who developed m yocardial infarction during a caesarean section under spinal anaesthesia gi ves rise to the assumption that an early stage of coronary artery disease m ay be the third cause that has to be considered. Probably as a consequence of phases of tachycardia and hypertension during the course of anaesthesia, the patient developed a myocardial infarction that she survived without seq uelae. While coronary angiography showed normal coronary vessels, an intrav ascular ultrasound study (IVUS) demonstrated an atheroma in the left main c oronary artery with a ruptured fibrous cap. Laboratory screening for risk f actors of coronary artery disease (CAD) showed hypercholesterinemia, increa sed factor VII activity and hyperfibrinogenemia. Platelet aggregation was n ot inhibited by acetylsalicylic acid. It was pointed out recently that even in asymptomatic patients, plaques may be present in coronary vessels indic ating an early stage of CAD that cannot be diagnosed by angiography. Plaque rupture is often triggered by hypertension and may lead to myocardial infa rction, instable angina pectoris, or sudden ischemic death. As IVUS is a ne w diagnostic tool that allows diagnoses of even early stages of CAD we beli eve that myocardial infarction during pregnancy is more often caused by pla que rupture than may be expected according to the current literature.